Provider Demographics
NPI:1639249139
Name:VELURY, PADMASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMASHREE
Middle Name:
Last Name:VELURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5602 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9635
Mailing Address - Country:US
Mailing Address - Phone:580-531-6408
Mailing Address - Fax:580-531-4981
Practice Address - Street 1:4411 W GORE BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-536-5300
Practice Address - Fax:580-536-5304
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24968207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24M728913Medicare PIN
OKH17551Medicare UPIN